Treatment Of Large Renal Stones Research Articles

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

The Effect of Antibiotic Therapy Before Percutaneous Nephrolithotomy on the Frequency of Postoperative Complications: A Retrospective Cross-Sectional Study

Background: Percutaneous nephrolithotomy (PCNL) is commonly used in the treatment of large renal stones. Postoperative infections are a common consequence of these procedures. Objectives: The purpose of this study is to evaluate the effects of antibiotic therapy before PCNL on the possibility of developing fever and common complications after the procedure. Methods: We carried out a retrospective cross-sectional study involving 708 patients who had undergone PCNL at Razi Hospital in Rasht, covering the period from 2012 to 2022. Patients were allocated into two groups: Group 1 included 454 patients who had received antibiotic therapy, and group 2 included 254 patients who had not received pre-operative antibiotic therapy. Results: In group 1, there were 241 males (53.1%) and 213 females (46.9%), while in group 2, there were 138 males (54.3%) and 116 females (45.7%). In group 1, 82.7% of patients treated with antibiotics had a negative culture. The hospitalization time was 4.00 ± 1.75 days for group 1 and 2.26 ± 1.56 days for group 2. Fever was observed in 39 patients (11.2%) in group 1. Sepsis was seen in only one patient (0.3%) in group 1. There is a significant relationship between total hospitalization time (P = 0.000), hospitalization after the operation (P = 0.000), hypertension (P = 0.009), ischemic heart disease (P = 0.050), history of shock wave lithotripsy (P = 0.003), hydronephrosis (P = 0.000), age (P = 0.004), and hemoglobin levels (P = 0.000) with antibiotic therapy. Conclusions: Surgeon overprescription of antibiotics may lead to resistance, complicating outcomes and extending hospital stays after PCNL. Some complications remain unaffected by antibiotic therapy due to surgical experience.

The experience of a tertiary referral center with laparoscopic pyelolithotomy for large renal stones during 18 years

This study aimed to evaluate the outcomes of laparoscopic pyelolithotomy, including its efficacy and feasibility in treatment of large renal stones. All patients who underwent laparoscopic pyelolithotomy operations in a referral center were enrolled from 2003 to 2020. The final analysis included 436 patients. The total stone free rate was 88.3% and the stone-free rate for staghorn/multiple stones versus other types of stones was 81% vs. 91% (P = 0.002). Likewise, the total operation duration was 158 ± 50 and the operation duration for staghorn/multiple stones versus other types of stones was 171 ± 51 min vs. 153 ± 49 min (P < 0.001). The operation duration (169 ± 51 vs. 155 ± 58 vs. 155 ± 42 min) and hospitalization (4.5 ± 2.3 vs. 4.0 ± 2.2 vs. 3.6 ± 1.8) decreased with increasing the surgeons' experience over time. The outcomes of laparoscopic pyelolithotomy for children versus adults versus geriatric patients and in patients with normal versus abnormal kidney anatomy did not reveal statistically significant differences. Laparoscopic pyelolithotomy could be employed as an alternative surgical approach for patients with large kidney stones of any age or with kidney abnormalities provided that appropriate expertise is available to carry out the procedure.

Comparison of Efficacy of Percutaneous Nephrolithotomy between Supracostal and Subcostal Access in Patients with Renal Stone

Background: Percutaneous Nephrolithotomy (PCNL) is a prevalent surgical procedure for the treatment of large renal stones. The choice between supra-costal and sub-costal access is pivotal in optimizing patient outcomes. This study provides an in-depth comparison of these two approaches, contributing to the evolving discourse in urological surgery. Objective: To compare the efficacy and safety of supra-costal and sub-costal access in PCNL for the treatment of renal stones. Methods: A randomized controlled trial was conducted at the Department of Urology, Pakistan Institute of Medical Sciences, from May to October 2023. Sixty-four patients with renal stones larger than 2cm were enrolled and divided into two groups based on the access point: supra-costal (Group A) and sub-costal (Group B). Variables such as age, gender, duration of surgery, stone size, clearance rate, and complications were analyzed using Statistical Package for the Social Sciences (SPSS) Version 25. Results: The average age of participants was 37.20 ± 13.0 years, with surgery duration averaging 45.75 ± 4.98 minutes. The majority of participants were male (59.4%). Stone clearance rates were high in both groups (93.8% in Group A and 90.6% in Group B), with no statistically significant difference (P-value &gt; 0.05). Complication rates were 9.4% in Group A and 15.6% in Group B, also showing no significant difference. Conclusion: Both supra-costal and sub-costal accesses in PCNL are effective for renal stone clearance, with comparable success rates and complication profiles. The choice between these approaches can be based on individual patient anatomy and surgeon preference. Further research could explore long-term outcomes and patient-specific factors influencing the choice of access point.

Combined semirigid and flexible ureterorenoscopy for the treatment of large renal stones.

Ureteroscopy is recognized as a minimally invasive and readily accessible method with low morbidity, favorable outcomes, and rapid post-interventional recovery. Recent advancements in rigid and flexible ureteroscopes have enhanced their efficiency, durability, and capability to accommodate accessory instruments. In this retrospective analysis, we evaluated 75 consecutive patients with large renal stones (stone burden between 2 and 4 cm) treated using a combination of semirigid and flexible ureteroscopy between January 1, 2020, and December 31, 2021. Stone properties and anatomical information were collected from the image archives derived from computed tomography (CT) and/or KUD radiography. Multiple ureteroscopy sessions were required for bigger stones. The length of the hospital stay, operation time, stone-free rate, preoperative and postoperative complications, and complication rates were examined. The average age of the patients was 52.7 years, with a mean stone burden of 31.45 mm. Most stones were in the renal pelvis, followed by the upper calyx. The average operative time was 56.2 minutes. After the initial ureteroscopy session, the stone clearance rate was 76%, which increased to 92% after two ureteroscopy sessions. Complication rates were evaluated using the Clavien-Dindo modified system, with an overall complication rate of 18.4%. Most of the complications were Clavien Grades I and II, with no grade V complication encountered. Large renal stones can be treated by combining semirigid and flexible ureteroscopy to reduce the operative time and protect the flexible ureteroscope.

Minimally Invasive Percutaneous Nephrolithotomy Combined with Holmium: YAG Laser for Treatment of Large Renal Stones

Minimally Invasive Percutaneous Nephrolithotomy Combined with Holmium: YAG Laser for Treatment of Large Renal Stones

Totally tubeless single access tract mini-percutaneous nephrolithotripsy in treatment of large burden\u2009>\u20092-cm and/or complex renal stones: a case series of 62 patients

BackgroundLimited literature has focused on the use of totally tubeless mini-percutaneous nephrolithotomy (PCNL) for the treatment of large renal stones. We present our findings of treating patients with large and/or complex renal stones using single renal access totally tubeless mini-PCNL.MethodsFrom March 2018 to May 2021, 62 consecutive cases in which single tract totally tubeless mini-PCNL was used to treat complex renal stones were enrolled, all with calculi > 2 cm. All procedure of puncture and dilation were guided by fluoroscope. The complexity of stones was assessed according to the Guy’s Scoring System (GSS). The surgical duration, length of hospital stay, analgesia requirement, stone-free rate, and perioperative morbidity were assessed.ResultsThe mean preoperative stone burden was 36.69 ± 19.76 mm (above 2 cm in all cases), mean surgical duration was 61.93 ± 40.84 min (range 15–180 min), and mean hematocrit reduction was 4.67 ± 2.83%. Postoperative Nalbuphine was used in 6 patients. The mean length of stay was 2.46 ± 1.19 days (range 2–8 days), and the postoperative stone-free rate was 83.9% (52/62), and 87.1% (54/62) after auxiliary ESWL. The overall complication rate was 14.5%, the majority of complications being postoperative transient fever.ConclusionFor the treatment of large bursen > 2 cm and/or complex renal stones, totally tubeless single tract mini-PCNL ensures a feasible SFR, low morbidity and short hospital stay. According to the low complication rate in our study, the totally tubeless manner was not associated with an increased risk of postoperative morbidity, and patients benefited from decreased postoperative analgesics use.

Tranexamic acid vs placebo and its impact on bleeding, transfusions and stone-free rates in percutaneous nephrolithotomy: a systematic review and meta-analysis.

IntroductionPercutaneous nephrolithotomy (PCNL) is the standard of care for the treatment of large renal stones. Bleeding-related complications remain a major concern when performing this procedure. Tranexamic acid (TXA) has recently been studied in both urologic and non-urologic procedures to reduce bleeding, transfusions and complications.Material and methodsIn June 2021 a systematic review was conducted following PRISMA guidelines on randomized prospective studies comparing the effects of TXA on bleeding complications during PCNL. Data was analyzed using Review Manager 5.3.ResultsEight studies were included with a total 1,201 patients, of which 598 received TXA and 603 received placebo. TXA was associated with less bleeding (decreased change in hemoglobin) -0.79 Hb g/dl [-1.09, -0.65] p <.00001 and decreased transfusion rates (OR 0.31 [0.18, 0.52] p <0.0001). This was also associated with lower complication rates, both minor, major and overall, OR 0.59[0.41, .85] p = 0.005, OR 0.31 [0.17, 0.56] p = 0.0001 and OR 0.40 [0.29, 0.56] p <0.00001 respectively. TXA was also associated with improved stone-free rates as compared with placebo (OR 1.79 [1.23, 2.62] p = 0.003). TXA resulted in shorter operative times (11.51 minutes [-16.25, -6.77] p =.001) and length of stay (-0.74 days [-1.13 -0.34] p = 0.0006). Two pulmonary embolisms were registered in a single study in the TXA group.ConclusionsIn this meta-analysis, the use of TXA during PCNL was associated with a statistically significant reduction in the following parameters when compared with placebo: change in hemoglobin, transfusion rates, complication rates, operative time, and length of stay. It was also associated with improvement in stone-free rates. These data should be considered by surgeons performing PCNL.

Hydroperitoneum: A complication of mini PCNL in pediatric age group? -A case report

Abstract&#x0D; Renal stones constitute 40% of renal disorders in Pakistan with silent stones constituting up to 3%. Nephrolithotomy and Pyelolithotomy were the only surgical options available for the treatment of large renal stones, with high rate of complications. Percutaneous nephrolithotomy (PCNL) has now become the mainstay of treatment for large renal stones over the past 30 years. Recent advances in equipment and technology has made PCNL the gold standard for this disease, resulting in removal of stones with shorter recovery time and decreased morbidity and mortality, and with few complications&#x0D; Case Discussion&#x0D; A boy aged 13 years, underwent mini PCNL for treatment of left side renal stone causing hydronephrosis, previously evaluated by KUB X-Rray and non contrast CT scan. His retrograde-percutanous access to the collecting system was done under fluoroscopic guidance. At the end of procedure, patient revealed taut and distended abdomen. Aspiration revealed presence of intraperitoneal fluid. Patient was effectively treated with immediate placement of abdominal drain with improvement of clinical presentation&#x0D; Conclusion&#x0D; Hydroperitoneum is a rare complication of conventional PCNL. Based on our experience and review of published literature, our case of hydroperitoneum after mini PCNL, is the first of its kind. A high degree of sensitivity and knowledge of this complication during PCNL in children would help identify and manage this complication in future. We recommend examination of abdomen post-PCNL in every child before he/she is brought out of anesthesia.

Comparison of Guy's, S.T.O.N.E. and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Eldery Patients.

To evaluate the efficacy and reliability of Guy's (GSS), S.T.O.N.E., and CROES scoring systems developed to predict percutaneous nephrolithotomy (PCNL) outcomes in aged patients. StudyDesign: Descriptive study. Department of Urology, Ministry of Health University Izmir Bozyaka Training and Research Hospital and Department of Urology, Faculty of Medicine, Amasya University, Turkey, from April 2011 to January 2020. Patients aged 65 years and over, who underwent PCNL for kidney stones, were retrospectively analysed. The patients' clinical and perioperative characteristics and the radiological features of the stones were obtained from the prospectively recorded data. GSS, S.T.O.N.E. and CROES nephrolithometry scores were calculated for each patient and their relation with stone-free status, complications, and perioperative findings were analysed. A total of 147 patients were included in the study. Stone-free status was achieved in 76.0% of the patients, and complications developed in 27.2%. All three scoring systems were associated with stone-free status and complication development. GSS (OR=0.213,p=0.005) and S.T.O.N.E. (OR=0.601, p=0.042) scores were detected as independent markers for stone-free status, while the CROES score was not an independent marker. Only diabetes mellitus was determined to be an independent marker for the development of complications (OR=2.375, p=0.045). PCNL is an effective and safe treatment method with high stone-free rates in the treatment of large renal stones, but care should be taken in terms of cardiac risks. The results of this study showed that GSS and S.T.O.N.E. scoring systems were effective and reliable in predicting stone-free status. Key Words: Aged, Nephrolithotomy, Percutaneous, Comorbidity, Stone-free status, Treatment outcome, Complications, Scoring systems.

Retrograde intrarenal surgery in the management of solitary large renal stones, 2-3 cm: a single center experience

Background: Nephrolithiasis represents a major health burden worldwide. Several treatment options are available for renal stones such as open stone surgery, percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shockwave lithotripsy. PCNL is considered the gold standard treatment for large renal stones (&gt;2 cm); however, it is associated with higher blood loss, complication rates, and longer hospitalization. In this setting, we aimed to assess the value of RIRS in the management of single large renal stones between 2-3 cm. Methods: The database of our center was reviewed to include all the patients who underwent RIRS for single large renal stone (2-3 cm) between February 2018 and April 2019. All the patients were evaluated by preoperative computed tomography to evaluate the stone size, site, and density. Furthermore, the following variables were also collected; pre- and post-operative hemoglobin and creatinine, the operative time, stone free rate (SFR), and duration of hospital stay. All the statistical analysis was performed using SPSS version 20.Results: Overall, the data of 31 patients were retrieved for the current study. The mean age of the patients was 56.9±12.9 years, and the mean stone size was 22.6±7 mm. The mean operative time was 96.4±37.3 minutes and the SFR was 74.2% after single session of RIRS. No major postoperative complications were reported in the current series.Conclusions: RIRS is a safe and efficient alternative to PCNL in the management of single renal stones between 2-3 cm; however, further prospective studies are required to confirm these findings.

Efficacy and safety of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for treatment of large renal stones: a meta-analysis.

BackgroundWe aimed to compare the efficacy and safety of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) for treating renal stones larger than 2 cm.MethodsWe searched the PubMed, Embase, Web of Science, SinoMed, and Chinese National Knowledge Infrastructure databases for studies that compared the surgical outcomes of LPL and PCNL. We conducted a meta-analysis of the retrieved studies, expressed as weighted mean difference or risk ratios with 95% confidence intervals.ResultsWe included 25 studies (1831 patients). LPL was associated with a significantly higher stone-free rate, lower rates of blood loss, complementary treatment, blood transfusion, and complications, and less reduction in hemoglobin level compared with PCNL. LPL and PCNL were similar in terms of duration of hospital stay, conversion rate, changes in glomerular filtration rate and creatinine level, and mean time of postoperative analgesia. However, LPL was associated with a longer operation time than PCNL.ConclusionLPL appears to be more effective and safer than PCNL in patients with large renal stones, by increasing the stone-free rate and reducing blood loss, complementary treatment, blood transfusion, and complications compared with PCNL. LPL may thus be a useful modality for treating patients with large renal stones.

V04-01 KIDNEY STONES SURGICAL TREATMENT WITH 3 D MIXED REALITY ASSISTANCE FOR PERCUTANEOUS PUNCTURE

INTRODUCTION AND OBJECTIVE:Endoscopic Combined IntraRenal Surgery (ECIRS) involves simultaneously a percutaneous and endoscopic access for the treatment of large renal stones or for multiple large ...

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience.

Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single-center series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. Between February 2016 and March 2018, 70 patients with complex renal stones (Guy's Stone Score: 4) underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 22-40 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In two patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as treatment of large renal stones when endoscopic treatment failed or was not available. RPL permits to achieve an excellent stone free status, in a single definitive procedure.

Percutaneous Nephrolithotomy in Obese Patients, Is There Any Challenge?

Percutaneous nephrolithotomy (PNL) is a safe and effective procedure in the treatment of large renal stones in obese and non-obese patients with low rate of morbidity and high success rate in different groups of body mass index (BMI), some surgeons believe that morbid obesity increases the risk of complications of PNL, but different recent studies showed there were no significant differences. Objective: To analyze the outcomes of PNL in patients with different BMI and to assess the effects of obesity in the result of PNL in terms of efficacy & safety regarding total operative time, blood transfusion, organ injury, stone clearance, hospital stay, and the need of auxiliary procedures. Patients and methods: This is a prospective study on patients with different body mass indexes need PNL. Age above 18 years with no co-morbidity had been included in this study from Jan 2015-Oct 2016 in governmental & two private hospitals in Sulaimania, after application of exclusion and inclusion criteria. All patients had a questioner’s paper to agree on participation in this study. Patients were classified into 3 groups according to the World Health Organization (WHO) classification of body mass index (BMI). Standard PNL with ideal instruments had been used. Intra operative and post-operative findings recorded in Excel data sheet. The patients were followed for one month. The outcomes in these 3 groups were compared. Results & analysis of the data: A total 117 patients had PNL. There was no any statistically significant difference between different BMI groups intra operatively & post operatively in this study with (P value < 0.05) regarding stone clearance, operative time, hospital stay, organ injury, Hemoglobin drop, post-operative renal impairment, and post-operative fever. Conclusion: PNL operation is a relatively safe & efficacious treatment for patients having renal stone with different BMI range from normal to obese patients without significant challenge.

Emphysematous Pyelonephritis with Renal Calculi Treated with Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) today has become the first line treatment for large renal stones. The infective complications of PCNL in patients with emphysematous pyelonephritis EPN would be higher and be responsible for the increased morbidity. We retrospectively reviewed our hospital records of patients with EPN and renal stones undergoing PCNL, and assessed the outcome especially in relation to infection. Materials & Methods: The case records of all patients with EPN and renal stones having undergone PCNL at our centre were retrospectively reviewed and analyzed. The age, gender, presenting symptoms, features of septicemia, preoperative drainage, post-operative complications and outcome were recorded. Results: During the study period, 12 patients (eight females and four males) with a mean age of years who were diagnosed to have EPN, underwent PCNL for extraction of renal calculi. All patients were initially managed conservatively; five patients underwent cystoscopy and Double J stent insertion on the affected side and seven patients underwent PCN insertion. Six weeks later, PCNL was performed (Urine culture was negative) undercover of appropriate antibiotics and general anaesthesia. Nine patients had Class II; two patients had class IIIb and one patient had class IV complications as classified by Clavien-Dindo. All patients recovered well and post-operative x-rays showed clearance of stone in all. Conclusions: Percutaneous nephrolithotomy is a safe, viable option in patients with emphysematous pyelonephritis and renal calculi follows a period of conservative treatment and effective drainage of the pelvicalyceal system by either a ureteric stent or percutaneous nephrostomy. The calculi can be effectively managed with endoscopic measures with renal preservation and a good functional outcome.

Outcome of percutaneous nephrolithotomy for renal stones in Assiut Urology and Nephrology Hospital

ContextPercutaneous nephrolithotomy (PCNL) has become the standard treatment for renal stones not amenable to extracorporeal shock wave lithotripsy in many countries.AimsThe current study aims to evaluate the outcome of PCNL, in terms of efficacy and success rate, in the management of renal stones in our hospital.Settings and designThis is a descriptive case-series study.Patients and methodsA total of 230 patients, 173 men and 57 women underwent PCNL in our hospital between September 2013 and September 2015. The following clinical parameters were reported; stone site, size, serum creatinine, operative time, site of calyceal puncture, number of tracts, decrease in hemoglobin level, length of hospital stay, stone-free rate (SFR), and complications.Statistical analysis usedIntercooled STATA, version 9.2 was used. χ-Test or Fisher's exact test was used for comparison of the categorical data and Mann–Whitney U-test used to compare the noncategorical data.ResultsThe median age was 38 years (range: 3–75 years). The mean operative time was 110 ± 30 min, and hospital stay ranged from 2 to 8 days. The primary SFR was 70.9% after the first session of PCNL but the overall clearance was 87.7%. It was found that stone location, access puncture, access number, and operative time were statistically significant factors affecting SFR. The overall complications were 13%.ConclusionPCNL is considered a standard treatment for large renal stones. Stones distribution, access puncture, number of access, and operative time significantly affect the SFR. The usage of flexible nephroscope and a second-look nephroscopy improved the outcome.

The stone surgeon in the mirror: how are German-speaking urologists treating large renal stones today?

To elucidate the current treatment strategies of LRS in German-speaking Europe. Little is known about the treatment of large renal stones (LRS>3cm) in daily urological practice. LRS therapy can be, however, challenging and hazardous. A 39 item web-based survey was performed among urologists listed by the German, Austrian and Swiss Associations of Urology, addressing professionals treating LRS "on their own" and working in a German-speaking country. Uniparametric descriptions indicated as absolute numbers and percentages without p values, simple linear associations and bubble plots without arithmetic means or bar charts with standard deviation between targeted parameters and percentages were used. 266 of the 6586 responding urologists claimed to treat urinary stones on a regular basis. The majority of them were male (90.2%) and over 50 years old (42.9%). Most stones are treated in non-university hospitals (69.5%). 81.9% of all the institutions treat more than 150 cases/y. Open surgery is still performed in 45.5% of the centres, laparoscopy in 32%. Percutaneous nephrolithotomy (PNL) is the primary treatment option. Antimicrobial strategies vary considerably. Serious complications seem to be rare. However, quite a few responders reported treatment-related deaths. The main limitation is the absolute number of urologists performing LRS treatment, which is unknown. The German-speaking urologist treating LRS is a male and over 50. Although he performs PNL primarily, he is not averse to open surgery and SWL. He applies guidelines and employs modern equipment. Only antimicrobial strategies are out of line with the international standards.

Comparing the Efficacy and Safety of Ultrasonic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy: A Randomized Clinical Trial

BackgroundPercutaneous nephrolitotomy (PCNL) is the preferred treatment for large renal stones. There is a need for more comparative data for different lithotripters used in PCNL. ObjectiveTo evaluate the comparative safety and efficacy of ultrasonic and pneumatic lithotripsy in patients undergoing PCNL. Design, setting, and participantsThis randomized clinical trial was conducted at Labbafinejad University Hospital, Tehran, Iran. A total of 180 patients were selected and divided randomly into two groups: 88 patients to pneumatic and 92 to ultrasonic lithotripsy. InterventionStandard fluoroscopy-guided PCNL was performed using pneumatic or ultrasonic lithotripsy. Outcome measurements and statistical analysisThe primary outcome was the procedure success rate. We also evaluated other outcome measures including operation time, stone fragmentation and removal time (SFRT), length of hospital stay, and postoperative complications. We used SPSS software version 18.0 for data analysis. Results and limitationsThe two groups were similar in baseline characteristics. There were no significant differences between the groups in stone fragmentation and removal time (p=0.63), stone free rate (p=0.44), and hospital stay (p=0.66). SFRT for hard stones was shorter using pneumatic lithotripsy (p<0.001). By contrast, ultrasonic lithotripsy was associated with a shorter SFRT for soft stones (p<0.001). Postoperative complications were similar in the two groups. A limitation of this study might be the 3-mo follow-up period. ConclusionsIn general, there were no significant differences in the success rate and complications between pneumatic and ultrasonic lithotripsy. SFRT was significantly shorter using pneumatic lithotripsy for hard stones, and ultrasonic lithotripsy for soft stones. Patient summaryWe found no significant differences in the success rate and complications of percutaneous nephrolitotomy using pneumatic and ultrasonic lithotripsy. Ultrasonic and pneumatic lithotripsy differed in the time for stone fragmentation and removal for hard and soft stones.

Percutaneous nephrolithotomy: technique.

Percutaneous nephrolithotomy (PCNL) is considered to be the first line of treatment for large renal stones. Though PCNL comes with higher morbidity, its efficacy is unbeaten by other minimally invasive modalities. However, potential complications, such as bleeding, occur. Improved skills and modifications of the procedure may reduce the probability of adverse outcomes. This article discusses the current trends and standards in PCNL technique with special focus on all important steps as positioning, access, instruments, dilation, disintegration, and exit, including outcomes, complication management, and training modalities.